Rotator Cuff

What Is the Rotator Cuff?

The Rotator Cuff is the name of a group of four muscles and tendons that surround the shoulder joint. They connect the shoulder blade to the humerus which is the long upper arm bone. They work together to stabilise the shoulder joint and also help with shoulder movement.

What is a Rotator Cuff Injury?

Shoulder pain is a very common problem. About 70% of patients presenting to shoulder clinics have problems originating from the rotator cuff. Rotator cuff problems can be divided into rotator cuff tendinopathies and rotator cuff tears.

What Causes problems with the Rotator Cuff?

There are a number of different terms used for rotator cuff problems. Tendinitis, tendinopathy and rotator cuff impingement are all common terms used to describe problems within the rotator cuff tendons.

Tendinopathy: Occurs when the tendon has to cope with more load than it can manage. The amount of load the tendon can cope with will depend on what it is used to doing. For example a sportsperson/carpenter who is used to using their shoulder on a daily basis may be able to cope with large loads without any problem, yet in an older person who is not as physically active a small change in load (e.g. painting a ceiling) may be enough to irritate the tendon. Tendinopathy is divided into 3 stages, with more potential for healing in the earlier stages.

Tears: Are most common in people over 40. They often result from trauma such as a fall on the shoulder or outstretched arm. Tendons can be partially or fully torn. Persons who tear their tendon may have a background of tendinopathy.

What are the Common Signs and Symptoms?

Shoulder pain is the most common symptom. You may notice pain on certain movements such as putting your hand into the sleeve of your coat or reaching up overhead (eg to a high cupboard). Some people may have difficulty with overhead movements because of weakness. It is also common to have pain at night if you lie on the injured shoulder. The pain tends to worsen over time if you continue to use the shoulder as normal.

Treatment

Relative Rest

  • Relative rest is important. This means stopping doing the activity that aggravates the pain but do not stop moving your shoulder. It may help if you can improve your posture in sitting or when doing activities.
  • Your GP may prescribe Painkillers (Paracetamol) or Anti -Inflammatory tablets to help control your pain.
  • Steroid injections may sometimes be required to help settle the pain.

Physiotherapy

  • Physiotherapy has been shown to be as effective in managing this problem as surgery. Your Physiotherapist will identify and address any factors which may be aggravating the problem, and will show you exercises to gradually strengthen your shoulder muscles.

Surgery

  • Surgery may be considered in cases where all other options have failed. Surgery may be used to increase the space under the outside end of the collar bone, thereby taking some of the pressure off the tendon. A repair of any torn tendon may be included. There are a number of different ways of carrying out this surgery. 

Self-Management

  • Relative rest – carry on gentle movements to prevent you getting a stiff shoulder. Avoid any movements that increase the pain such as overhead movements or repetitive movements.
  • Seek further advice from GP or Chartered Physiotherapist.

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